Condition- Mitral Regurgitation

Question 1

What is mitral regurgitation?

Answer 1

Retrograde flow of blood from left ventricle to left atrium during systole through faulty mitral valve

Question 2

Which subest of the population is at greater risk of mitral valve prolapse?

Answer 2

Young females

Question 3

List some of the causes/ risk factors for the development of mitral regurgitations + what is the most common cause?

Answer 3

• Rheumatic Heart disease
• Infective Endocarditis
• Mitral Valve prolapse
• MI=> Papillary muscle rupture/ dysfunction (IHD/ cardiomyopathy)
• Connective tissue disease => Chordal rupture/ floppy mitral valve
• LV dilatation
• congenital
• cardiomyopathy

Question 4

List some of the presenting symtpoms of mitral regurgitation

Answer 4

• Signs of left ventricular failure:
• Chronic: APEX
  
  • Atrial fibrillation
  • Palpitations
  • Exertional Dyspnoea (+ orthopnoea)
  • Xtreme tiredness (fatigue)

Question 5

List some of the symptoms of Mitral Valve prolapse

Answer 5

Asymptomatic or can have sudden onset chest pain + palpitations

Question 6

List some signs of mitral valve prolapse on auscultation

Answer 6

• Mid-systolic click
• Late- systolic murmur
• Click moves towards S1 when standing and away when lying down

Question 7

What is heard on auscultation of a patient with MR?

Answer 7

• Holosystolic murmur at the apex which radiates to the axilla
• Soft S1
• S3 may be heard due to rapid ventricular filling in early diastole

Question 8

List some of the signs of MR on physical examination

Answer 8

• Pulse may be in AF
• Laterally displaced apex beat due to LV dilation
• Pansystolic murmur:
  
  • loudest at apex
  • radiates to apex
• Soft S1
• S3 may be heard due to rapid ventricular filling in early diastole
• Signs of LV failure
• Mitral Valve prolapse signs:
  
  • Mid-systolic click
  • late systolic murmur
  • Click moves towards S1 when standing and away when lying down

Question 9

What might be seen on an ECG of a patient with Mitral Regurg

Answer 9

• May be NORMAL
• May be in AF
• Or may have p mitrale (=left atriale hypertrophy)

Question 10

What might be seen on a CXR of a pt with MR?

Answer 10

ACUTE: LV failure (pulomnary oedema)

CHORNIC:

• Left atrial enlargement
• Cardiomegaly (due to LV dilation)
• Mitral valve calcification (if rheumatic heart disease)
• Pulmonary Oedema

Question 11

Which investigation needs to be conducted to confirm the diagnosis of MR?

Answer 11

Transthoracic echo- which assess severity of valve dysfunction + LV & LA size